[Microscopic spermatic vein ligation for nutcracker phenomenon complicated with left varicocele].

ABSTRACT

OBJECTIVE: To investigate the clinical effect of microscopic spermatic vein ligation in the treatment of nutcracker phenomenon (NCP) complicated with left varicocele (VC). METHODS: This retrospective study included 31 cases of NCP complicated with left VC treated in our hospital by subinguinal microscopic ligation of the left spermatic vein (group A, n = 11), open retroperitoneal high ligation of the left spermatic vein (group B, n = 11), or conservative therapy (group C, n = 9). The patients were followed up for 6－24 (15.3 ± 5.4) months. We compared the semen parameters, spermatic vein diameter, left testis volume, and recurrence rate among the three groups of patients before and after treatment. RESULTS: Compared with the baseline, the semen quality parameters were significantly improved in both groups A and B at 6 months after treatment (P<0.05) but reduced in group C (P<0.05); the spermatic vein diameter at rest and that at Valsalva maneuver were markedly decreased in groups A (ï¼»2.53 ± 0.27ï¼½ vs ï¼»1.84 ± 0.22ï¼½ and ï¼»3.53 ± 0.19ï¼½ vs ï¼»2.16 ± 0.25ï¼½ mm, P<0.05) and B (ï¼»2.62 ± 0.33ï¼½ vs ï¼»2.15 ± 0.43ï¼½ and ï¼»3.36 ± 0.25ï¼½ vs ï¼»2.44 ± 0.27ï¼½ mm, P<0.05) but increased in group C (ï¼»2.56 ± 0.28ï¼½ vs ï¼»2.94 ± 0.24ï¼½ and ï¼»3.33 ± 0.21ï¼½ vs ï¼»3.77 ± 0.26ï¼½ mm, P<0.05). No statistically significant differences were found in the left testis volume at 6 months after treatment in group A (ï¼»9.85 ± 1.86ï¼½ vs ï¼»10.27 ± 1.18ï¼½ ml, P>0.05), B (ï¼»9.77 ± 2.03ï¼½ vs ï¼»9.96 ± 1.72ï¼½ ml, P>0.05), or C (ï¼»9.83 ± 1.59ï¼½ vs ï¼»10.48 ± 2.05ï¼½ ml, P>0.05), nor in the recurrence rate between groups A and B (P>0.05). CONCLUSIONS: Hematuria, proteinuria and other mild symptoms of nutcracker phenomenon complicated with left VC can be treated palliatively by microscopic ligation of the spermatic vein, which can relieve the clinical symptoms, improve the semen quality, and protect the testicular function of the patient.